Paediatric asthma hospital utilization varies by demographic factors and area socio-economic status

SummaryObjectivesAssociations of emergency department (ED) visits and hospital admissions for asthma in children with demographics and area socio-economic status (SES) were examined to evaluate long-term trends and identify vulnerable populations.Study designRetrospective population-based trend and cross-sectional analyses.MethodsAsthma hospital admissions (2000–2007) and ED visits (2005–2007) for children aged 0–14 years living in Orange County, California were linked with zip-code-level SES data (2000 US Census). Annual population estimates were obtained to calculate age-specific admissions and ED visit rates. Average annual percentage changes (AAPC) were calculated with joinpoint analyses. The risks of ED visits and hospital admissions were estimated from SES indicators with negative binomial regression.ResultsRates of asthma hospital admissions and ED visits were highest among children aged 0–4 years, males and African Americans, and lowest among Asian/Pacific Islanders. African Americans and Hispanics/Latinos were more likely to be uninsured. Asthma admissions decreased significantly for all age groups over the study period. The greatest declines per 100,000 were among children aged 0–4 years (AAPC: −15.3%, 95% confidence interval −17.0% to −13.4%). Rates of hospital admissions and ED visits were significantly higher in low-SES groups. Hospital admission rates were 30–60% higher and ED visits were 80–90% higher in zip codes in the lowest tertile of median household income compared with the highest tertile of median household income.ConclusionsPaediatric asthma hospitalizations and ED visit rates are declining in Orange County. However, certain groups are disproportionately affected, including those living in areas with low SES. This information will help in targeting intervention strategies to children at highest risk for severe asthma episodes.